“PEOPLE ARE HURTING,” journalist Travis Lupick writes in his new book, Light Up the Night: America’s Overdose Crisis and the Drug Users Fighting for Survival. “They are learning that the American Dream is no longer a promise made to everyone. Corporate executives are paid more, employees are paid less, and economic inequality is approaching levels not seen since the Great Depression.”
Add in COVID-19 — with increased social isolation and a concomitant spike in depression and anxiety — and an abundance of synthetic fentanyl and carfentanil, and it should not be surprising that overdose deaths have increased dramatically since the pandemic began.
Many people, Lupick writes, have simply given up, dying in record numbers from suicide, alcoholism, and drug abuse. It’s a grim reality, laid out in stark detail, but Light Up the Night is not only a recitation of the harrowing. Instead, it’s also a hopeful look at the ways harm reduction and community organizing by the IV-drug-using community are shifting attitudes and agitating to end the War on Drugs.
Lupick’s research includes interviews with dozens of people, and their observations give Light Up the Night resonance and authority. Nonetheless, it’s his zeroing in on two longtime users, Louise Vincent in Greensboro, North Carolina, and Jessica Tilley in Northampton, Massachusetts, whose in-depth profiles pack the most significant punch. Their advocacy of needle exchanges, supervised injection sites, and drug decriminalization is inspiring, and their efforts to bring users together to promote their common interests are heartening.
At the same time, Light Up the Night is steeped in realism. Readers will see the ways that racism, sexism, homophobia, transphobia, poverty, violence, and abuse contribute to drug use. Likewise, the negative narratives that shame and stigmatize addicts.
Lastly, the history of the Drug War, including President Richard Nixon’s campaign goal of smearing anti–Vietnam War protesters and Black power activists, puts a sobering political frame around mass incarceration and the prison-industrial complex that developed in its wake. As Nixon aide John Ehrlichman told Harper’s Magazine, the 1968 campaign understood that “by getting the public to associate hippies with marijuana and Blacks with heroin, and then criminalizing both heavily, we could disrupt those communities.” “We could arrest their leaders,” Ehrlichman crowed, “raid their homes, break up their meetings, and vilify them night after night on the evening news.”
Needless to say, the strategy worked and Light Up the Night is a chronicle of the damage wrought and a vivid testament to the intrepid work of those trying to undo the harm it caused.
ELEANOR J. BADER: How did you come to focus on the IV-drug-using community?
TRAVIS LUPICK: I was a general assignment reporter at a newspaper in Vancouver, British Columbia, called The Georgia Straight. In 2014, we noticed that the number of overdose deaths was starting to climb. I wrote one article, and then another and another. Over the next 18 months, overdose deaths increased so much that this became my full-time beat.
At the time, I was living in Vancouver’s Downtown Eastside, where drug use was visible on the street. I would be waiting for my bus to work in the morning, and next to me, there would be a man on the ground with a sheet laid over him. On my way home from work, I would walk by paramedics responding to an overdose outside my building. The statistical increase in deaths, after fentanyl and carfentanil arrived, was something I saw with my own eyes. For several years, this was my whole life, writing articles about it for the paper and then, in my free time, writing my first book, 2018’s Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction.
We know that Adverse Childhood Experiences (ACE), including physical and sexual abuse, contribute to substance abuse. How can treatment for trauma be incorporated into harm reduction?
When I first learned about ACE, it was like a bomb going off for me, and shifted how I thought about drug use. The book In the Realm of Hungry Ghosts, by Dr. Gabor Maté, helped me understand that many people who use hard drugs are self-medicating. Unfortunately, our medical and other systems are so screwed up that they don’t offer any real help to those who are hurting, which is why so many users avoid them. Even worse, when police chase after them, we’re further victimizing the victim. Even when people say the right thing, “addiction is a disease,” they often still treat it as a police matter, which makes no sense. It is cognitive dissonance.
We also need to understand that criminalization causes long-term harm, because an arrest record makes it very difficult for people to find jobs. My research found that 87 percent of large companies run background checks on a random selection of job applicants and 69 percent run them on everyone. Racism then compounds this. If a white person admits to having a criminal record in the initial interview, their chance of being called back is just 17 percent. It’s five percent for Black applicants. These businesses act as if drug use deserves perpetual punishment.
But let me get back to the question. Recovery programs and therapists are beginning to see that for many people, drugs are a way to cope with childhood trauma or mental illness and are no longer insisting that a user abstain before treatment can begin or continue. There is still a long way to go, however.
You argue that drug companies are not the sole reason opioid use has increased in the US. Didn’t the pharmaceutical companies flood the market with pills?
My assessment is controversial. As I see it, something was happening before Purdue Pharma and other drug companies flooded the market with pain pills. If it hadn’t been the pharmaceutical companies, someone else would have come along and taken advantage of inequality, stress, and childhood trauma. Perhaps these companies deserve to be demonized, but I see them only as the latest culprit.
At the community level, the problem is not the dealer, but the society and the systems that cause so many people to seek them out. The dealer is just another capitalist. Or, as I discuss in the book, the dealer is often not even a dealer at all, but rather is another person addicted to drugs, more worthy of our compassion, I would argue, than deserving of criminal punishment.
Why do you think harm reduction works to reduce overall drug use?
The idea is counterintuitive, but it’s the truth. There are plenty of academic studies showing that if you use IV drugs and you frequent a needle exchange or a supervised injection site, you are more likely to use less or even stop using IV drugs altogether. A needle exchange can serve as a point of entry to the health-care system, so there’s that. But I think what it really is, is the human interaction. All of a sudden you have a contact point with someone who cares about you, so instead of being in a dirty alley and looking over your shoulder for police, you have a nurse looking at you with care and concern.
Opponents of supervised injection sites and needle exchanges — harm reduction — say that these programs coddle users and encourage IV drug use.
The debate over harm reduction forces us to ask ourselves what we’re really trying to accomplish. Do we want to help IV drug users improve their health, eventually end or decrease their drug use, and reenter the mainstream economy, or do we want to punish them with the physical pain of withdrawal or with incarceration? I don’t think advocates of the Drug War ever ask themselves this question. At least they never answer it honestly.
They want users to feel shame. This is why even proponents of harm reduction — people who know that the cardinal rule of injecting hard drugs is to never use alone — sometimes die of an overdose. Harm reduction activist Dan Biggs is one example. Unfortunately, he died after using alone. Even those who shout the loudest about being careful can die because the stigma of using is so great. It is drilled into people that they need to hide their use, even when they know better, even when they know it could kill them.
The same debate exists around naloxone. Is it better to punish someone with death or help them survive? Being administered naloxone is not fun. If you have opioids in your system, it is intensely unpleasant; you instantly go from a euphoric high to total withdrawal.
On a related note, let me tell you about something that happened in Vancouver. In 2003, the first supervised injection site opened, and people marched in the streets in protest. A year later, the protesters admitted they’d been wrong. The same business owners who had marched against supervised injection, now rallied in its support. They had found that the drug users who previously had injected in their doorways, were now inside the site. And the needles that had previously been discarded on the sidewalks outside their shops, were now disposed of inside the injection site or collected by its staff. Many initial opponents of Vancouver’s injection site became some of its most vocal defenders.
Light Up the Night also addresses sensory sensitivities to certain fabrics, loud noises, and bright lights.
So many people I’ve interviewed have told me that life is just too much for them. Most of us are built for this world, can sufficiently shield ourselves from its harsher realities, and get along fine. Others can’t, and we don’t make room for them in our society; some adapt by using opioids. They do not deserve to be sent to prison.
Has there been any momentum on ending the Drug War?
There is a growing perception that the War on Drugs is softening. Yes, there is bipartisan support for decreasing mandatory minimum prison sentences. Even under Trump, people generally agreed that mass incarceration is too expensive and too harsh. At the same time, lawmakers seem increasingly desperate to show their constituents that they are doing something about fentanyl and carfentanil. The reality is that arrests in some categories of drug crimes are actually speeding up, not declining. Furthermore, new laws have been passed to make it possible for someone to be charged with murder if they give someone fentanyl and it causes their death — however unintentional. There are efforts to fight these measures by people who use drugs. They are organizing at the local and national levels to create a de facto lobbying group to end the War on Drugs and promote their own well-being. But it’s a long, uphill battle.
How did you find Louise and Jessica, the two women you zero in on in Light Up the Night?
I met both women on the book tour for my first book, Fighting for Space. I knew I wanted to write another book about the Drug War and was looking for people to interview everywhere I went. They were the two most fascinating, impressive, and caring two that I met. When I got to Boston, I was asked to help set up a mock supervised injection site for a hospital presentation. That’s where I met Jess. Over the next two years, her story slowly came out. I took half a dozen trips to Northampton, Massachusetts, her picturesque New England hometown, to interview her there. We grew quite close. The trust she’s placed in me is enormous.
I met Louise after speaking at a church in Greensboro, North Carolina. She was in the hospital and a friend of a friend asked me to deliver flowers to her. When I arrived, she was being prepped for her second amputation and, at the same time, was writing emails, talking on the phone ahead of a conference, and taking part in a Zoom meeting with activists around the country. Her room was a buzz of activity and, seeing her do five things at once, I knew instantly that she was someone I needed to know. She told me I could visit anytime, so a few months later, I called and asked if I could return to Greensboro and stay with her. She’s amazing. She’s been through a dozen tragedies and keeps going and going.
Her story about trying to access methadone is eye-opening.
Has there ever been another component of health care where patients are forced to stand outside in all kinds of weather and wait for someone to call them inside so they can wag a finger at them and watch as they swallow their medication? Many argue that methadone replaces one drug with another, but methadone is the number-one way to get someone off of opioids. Nevertheless, we make it hard to access. Until COVID, distribution sites would never give out more than one dosage at a time. Louise often travels for her job so she sometimes misses appointments. This got her kicked off methadone for noncompliance. It was ridiculous. But when COVID hit, people were suddenly able to get several doses at one time. And guess what? The sky did not fall and there was not a wave of methadone overdoses.
I was amazed by the work of the Urban Survivors Union (USU) in creating a community of users to advocate for their own well-being.
The Urban Survivors Union is a force to be reckoned with. Because of COVID, the USU has had to shift its work online and it’s become harder to organize because overdose deaths have skyrocketed, killing many of its members. The number-one rule — do not use alone — had to be discarded because everyone had to isolate and distance. The USU has taken a big hit. Many members have died but the group continues to do what it can, which is still a lot. Outreach continues.
We tend to think of IV-drug users as down and out, rather than as professionals, concerned parents, and savvy activists. We know intellectually that people in every demographic use drugs, but the stereotype persists.
Biases are hard to turn around, especially when they are deeply ingrained. Most of us are good people, but our biases are there and unless someone prods us, we usually don’t even realize we have them. We can start to turn this around by defining our goals. If it’s to save lives, step one is decriminalizing possession and drug use. As I write in the book, people are not dying because they use drugs. They’re dying because they don’t know what their drugs contain. If illicit narcotics were legalized and regulated, like alcohol, overdoses might still occur, but they would happen far less frequently, and people would be less afraid to ask for help. A common refrain in the harm reduction community is that this is not an overdose crisis; this is a crisis of government policy.